There is a medical specialist who wants to ensure that people with paralysis live their best possible life. They identify the cause of the person's paralysis if it is not already well established. They treat the medical complications of paralysis such as bowel and bladder dysfunction, pressure sores, spasticity, swallowing problems and pain. They work with the whole team, such as PT, OT, Speech, Psychology, and other doctors.

Who is this amazing medical conductor? A magical unicorn? Nope, a physiatrist. Not a psychiatrist. Not a podiatrist. A physiatrist. A Physical Medicine and Rehabilitation (PM&R) physician.

You've never heard of a physiatrist? You are not alone. Although physiatry has been around since the 1940s, our numbers are still small. When this author passed her PM&R boards in 1992, there were just over 3,000 others who had ever passed the PM&R boards. In 2021 approximately 14,000 people have been board certified in PM&R. By contrast, 410,000 Internists and Family Medicine doctors have been board certified.

The American Academy of Physical Medicine and Rehabilitation defines the specialty as a field which "aims to enhance and restore functional ability and quality of life to those with physical impairments or disabilities affecting the brain, spinal cord, nerves, bones, joints and muscles. The physiatrist's goals are to maximize patients' independence in activities of daily living and improve quality of life."

The training of physiatrists combines neurology and orthopedics with a focus on treatments that improve people's ability to dress, walk, work, etc. Here are some generalizations - physiatrists love to see improvement in people's day-to-day lives. Orthopedic surgeons love to be in the operating room. Neurologists love to diagnose. As a result, it is quite common to see outpatient physiatrists partner with orthopedists or neurologists so together they ensure that the patient gets the full care needed.

If you stayed in an inpatient rehabilitation hospital, you probably had a physiatrist as your main doctor. He or she would have ordered your therapy and equipment, coordinated the team, and managed any medical problems during your stay. In the blur of your stay, you might not have realized they were a physiatrist. Because many of the physiatrists who work with people with paralysis are in rehabilitation hospitals, other doctors don't always know what we do.

Many doctors do not know a lot about physiatry.

When a person has paralysis, the time in the hospital is a brief part of their journey. Paralysis can affect your body and spirit in ways beyond the limitations of mobility. However, no matter what type of living arrangement you have, a physiatrist can update your therapy and equipment orders. They can discuss new technologies, manage spasticity, prevent contracture, manage bowel and bladder programs, and help with complications such as autonomic dysreflexia. If you cannot find a good physiatrist in your area, consider the outpatient departments of spinal cord injury centers that often have doctors and therapists devoted to helping people with paralysis live their best lives. Telemedicine is now much more available, making distant doctors more accessible.

Let me know how it goes, I am rooting for you.

Dr. Gerda Maissel is the founder and President of My MD Advisor, a unique patient advisory service dedicated to helping people with complex conditions make informed choices and have the best experience possible within the medical system. She focuses on clients with spinal cord injury and other forms of paralysis as well as elders. She can be reached at [email protected]. Her web site is Mymdadvisor.com